Abstract：
BACKGROUND: The wearing-off phenomenon is characterized by the recurrence of motor and non-motor symptoms of Parkinsonism during a period free from levodopa. It is a pivotal aspect marking the end of the pharmacological \"honeymoon\" period in Parkinson\'s disease (PD). A growing body of literature is connecting sex with the likelihood of developing fluctuations. We investigated such an association in a post-hoc analysis of the large WORK-PD study.
METHODS: WORK-PD analyzed the usability of the wearing-off questionnaire 19 (WOQ19) in clinical practice and included cross-sectional data on age, disease duration, time on levodopa, Hoehn and Yahr stage, and WOQ19 scores of 532 PD patients. In the present study, we selected patients with an exposure time to levodopa of at least 1 year.
RESULTS: A total of 380 patients were included. Women reported a higher number of wearing-off symptoms than men (6.09 ± 3.39 vs 4.96 ± 3.11, p = 0.0006). Sex groups also differed in non-motor symptoms (2 ± 1.9 vs 1.5 ± 1.5, p = 0.021), particularly behavioral wearing-off scores being higher in women (p < 0.001). The latter were primarily featured by anxiety-related phenomena. Finally, there was a significant interaction between behavioral symptoms, sex, and age at onset (df = 2, F = 9.79, p < 0.0001), whereas no such interaction was observed with levodopa exposure and motor impairment, unlike motor symptoms.
CONCLUSIONS: Women showed a greater propensity than men to experience wearing-off, particularly non-motor fluctuations on the anxiety spectrum. The latter may demonstrate a lesser reliance on dopamine compared to motor symptoms. This observation could be underpinned by biological variances between genders at the neurotransmitter level.
METHODS: WORK-PD analyzed the usability of the wearing-off questionnaire 19 (WOQ19) in clinical practice and included cross-sectional data on age, disease duration, time on levodopa, Hoehn and Yahr stage, and WOQ19 scores of 532 PD patients. In the present study, we selected patients with an exposure time to levodopa of at least 1 year.
RESULTS: A total of 380 patients were included. Women reported a higher number of wearing-off symptoms than men (6.09 ± 3.39 vs 4.96 ± 3.11, p = 0.0006). Sex groups also differed in non-motor symptoms (2 ± 1.9 vs 1.5 ± 1.5, p = 0.021), particularly behavioral wearing-off scores being higher in women (p < 0.001). The latter were primarily featured by anxiety-related phenomena. Finally, there was a significant interaction between behavioral symptoms, sex, and age at onset (df = 2, F = 9.79, p < 0.0001), whereas no such interaction was observed with levodopa exposure and motor impairment, unlike motor symptoms.
CONCLUSIONS: Women showed a greater propensity than men to experience wearing-off, particularly non-motor fluctuations on the anxiety spectrum. The latter may demonstrate a lesser reliance on dopamine compared to motor symptoms. This observation could be underpinned by biological variances between genders at the neurotransmitter level.
摘要：
背景：磨损现象的特征是在无左旋多巴期间，帕金森病的运动和非运动症状复发。这是标志着帕金森病（PD）药理学“蜜月期”结束的关键方面。越来越多的文学将性别与发展波动的可能性联系起来。我们在对大型WORK-PD研究的事后分析中调查了这种关联。
方法：WORK-PD分析了磨损问卷19（WOQ19）在临床实践中的可用性，并包括有关年龄的横断面数据，疾病持续时间,左旋多巴的时间，Hoehn和Yahr舞台,532例PD患者的WOQ19评分。在本研究中,我们选择了左旋多巴暴露时间至少为1年的患者.
结果：共纳入380例患者。女性报告的磨损症状数量高于男性（6.09±3.39vs4.96±3.11，p=0.0006）。性别组的非运动症状也有所不同（2±1.9vs1.5±1.5，p=0.021），尤其是女性的行为磨损分数更高(p<0.001)。后者主要表现为与焦虑相关的现象。最后,行为症状之间有显著的相互作用，性别,和发病年龄(df=2，F=9.79，p<0.0001)，而与左旋多巴暴露和运动障碍没有观察到这种相互作用，不像运动症状。
结论：女性比男性表现出更大的磨损倾向，特别是焦虑谱上的非运动波动。与运动症状相比，后者可能对多巴胺的依赖性较小。这一观察结果可以得到神经递质水平上性别之间生物学差异的支持。
方法：WORK-PD分析了磨损问卷19（WOQ19）在临床实践中的可用性，并包括有关年龄的横断面数据，疾病持续时间,左旋多巴的时间，Hoehn和Yahr舞台,532例PD患者的WOQ19评分。在本研究中,我们选择了左旋多巴暴露时间至少为1年的患者.
结果：共纳入380例患者。女性报告的磨损症状数量高于男性（6.09±3.39vs4.96±3.11，p=0.0006）。性别组的非运动症状也有所不同（2±1.9vs1.5±1.5，p=0.021），尤其是女性的行为磨损分数更高(p<0.001)。后者主要表现为与焦虑相关的现象。最后,行为症状之间有显著的相互作用，性别,和发病年龄(df=2，F=9.79，p<0.0001)，而与左旋多巴暴露和运动障碍没有观察到这种相互作用，不像运动症状。
结论：女性比男性表现出更大的磨损倾向，特别是焦虑谱上的非运动波动。与运动症状相比，后者可能对多巴胺的依赖性较小。这一观察结果可以得到神经递质水平上性别之间生物学差异的支持。
